It gave me an insight into the emotional and physical effects of child abuse - something that I never had before, something I probably won't be exposed to in much detail in medical school - and it's made me realise how wrong those who say "they should just get over it" really are.
It's made me understand that a child's development isn't just restricted by things like physical and sexual abuse and starvation (though these factors contribute to a huge amount of developmental issues), but also by things such as a stressful environment to grow in and a lack of a loving caregiver.
It's made me see how it affects people beyond just their childhood and how hard it must be for people to come out of it.
And it's made me wonder, if these issues are so much more prevalent than I thought in Australia, a relatively well off country, imagine how it must be to grow up as a refugee, in a warzone, or while being malnourished...
I'll begin by introducing the concepts and trends of child abuse and neglect, in both developed and developing countries, then continue on to the long term neurological, physical and psychological effects of this issue and finish with how it's currently being dealt with, and how that can improve. Click on the headings below if you wanna skip to a particular section.
Contents:1) The Patterns of Child Abuse and Neglect
ia) What constitutes child abuse or neglect?
ib) What are the patterns of abuse in the developed world?
ic) What are the main causes of child abuse in the developing world?
2) The mechanisms behind the physical, psychological effects of abuse and neglect, and its long lasting effects.
iia) The importance of childhood (and teen) development, and the important role adults play in normal developement.
iib) The mechanisms behind stress hormone induced changes to the body.
iic) The effects of stresses on the brain; The effects of severe abuse and neglect on Roman Orphansit
iid) The mechanisms behind lowered brain volume, trauma and malnutrition, and psychological changes with abuse/neglect.
iie) How it affects physical and mental health in adult survivors.
3) Dealing With Child Abuse
iiia) Identifying child abuse victims
iiiax) Physical signs of abuse and neglect; when you need to suspect and report child abuse.
iiib) Coping mechanisms in children and adults
iiic) The system for how we deal with child abuse in the developed world (an ideal setting)
iiid) What are the problems in this system? How do we resolve them and improve the system?
iiie) What are the goals of psychological therapy, for children
iiiex) For adults
iiif) How to reduce the occurrence and impacts of abuse/neglect in the third world; (improving economic structure, restoring culture, dealing with trauma)
iiig) What YOU can do about it.
Summary - YOU CAN MAKE A DIFFERENCE.
Comment anything you want to add.
Different countries have differing patterns of child abuse, not only because of the differences in econimics and geopolitical stability, but also because of different paradigms and definitions of what child abuse entails. Environmental and economic factors play a huge role in child development; the decisions a struggling, sustenance farmer in hugely conflicted Somalia would be forced to make to survive would be tantamount to neglect in Australia, for instance.
In the third world in particular (though it's relevant all over the world) "rates of abuse and neglect can be thought of as indicators of the quality of life for families, and maltreatment can be viewed as a symptom, rather than a cause, of difficulties in family and individual functioning." 
By analysing the physical and psychological impacts of child abuse in more privileged countries, we can begin to grasp the impacts of global disasters, conflict and poverty on children all around the world.
- Sexual Abuse
- Physical abuse/torture
- Mental/emotional abuse
- Exposure to domestic violence
- Substance abuse (or exposure to this)
- Physical Illness
- Difficulty with school work/maintainence of expectations
- Lack of attention from parents
- Post Partum depression (occurs in 5 - 25% of women and causes a less loving enviornment)
- Too much work or expectation.
Patterns of Child Abuse in Australia:
In Australia, children aged less than 1 year were the most likely to be the subject of abuse or neglect (with 13.2 incidents per 1,000 children),
followed by children aged 1–4 years (8.4 per 1,000 children). This seems staggering as it is - apparently 1 in every 100 children weren't taken care of properly after birth - but it's important to note that neglect is included in this figure. Just as important though is that the effects of neglect are often just as bad as physical and sexual abuse.
A Representation of Child Abuse in Developed Nations:
Unfortunately, Aboriginal Australians were almost 8 times more likely to be a subject of this abuse.
40,000 kids were in out of home care last year. That's 1/40 of all kids in Australia. 95% were in foster care or living with relatives, but 5% were in institutions of some kind. And the total number of notifications of possible abuse was very high as well, as seen below.  sources from many studies, and government statistics were compiled in this factsheet.
Possibly because of media attention, perpetuated by large scale investigations like the Royal Commission into Institutional Reponses to Child Abuse, people have the impression that child abuse occurs through institutions or from deranged psychopaths. But in reality, most incidences of child abuse in Australia, in fact 80% of them, were perpretated by family members (63% of those were by immediate family members).  And most cases weren't single incidences, rather, prolongued, repeated, more complex traumas. Here are some sources for the rates of child abuse in other countries, such as the US, the UK and Europe (pages 8 - 25).
The immediate and longstanding physical and developmental manifestations of this issue I'll delve into in the next section, but the eery sounds of the street, indicating a world passing by, uncaring; coupled with the bleak, blank intonation of the child in this video highlights the desolate, impairing nature of both malnutrition and child labour.
Sexual Abuse/Prostitution and Slavery
War and Conflict:
Something I haven't talked about thus far, but definitely has just as impact as any other form of child abuse, is the issue of stress and emotional abuse. The Child Welfare Information Gateway suggests that more children suffer from neglect and emotional abuse than physical and sexual abuse combined 
In itself, stress of the primary caregiver, which can be felt and experienced by children even as babies and toddlers, is also something that can't be helped. It's when it occurs for a sustained period of time that it becomes an issue. In a warzone, during tough economic times, periods of domestic violence and in women with post partum depression, that stress can't be helped. Efforts to manage it, or hide it from the baby should be taken, but awareness of this issue and knowledge of how to manage stress isn't easily available.
Emotional abuse, however, is something that isn't as easily quantifiable in many regions, but definitely existant. Psychological maltreatment can be further broken down into 5 components; rejection - the abandonment or refusal of showing affection toward a child, isolation - preventing children from engaging in normal social activities; terrorising - with intense punishments; ignoring and corrupting - the purposeful development of false, dubious social values . Emotional abuse is prevalent all over the world, and rates of trauma due to it are similar, despite huge disparities in causes between developed and developing world children. Personal neurophysical problems and emotional abuse suffered by the parent makes them more likely to be emotionally abusive to their kids, but there is an aspect of societal pressure, applied by both the parents and by children toward themselves which constitute and lead to emotional abuse too. And the effects of this are palpable, with emotional abuse being a major contributing factor to maladaptive, unsocial being later in life . This video below shows the power of words in truest form, and describes a growing problem in many nations of high expectations on kids, especially in Asian nations; India for instance, has the second highest rate of suicides in the world, and the major contributors are those ages 15 - 24 .
An inspiring project designed to raise awareness of the impact of emotional abuse in children, in part caused by the pressure to perform.
As seen above, the first 3 years of life features huge amounts of brain development, with both neurons (brain cells) being formed and synapses (linkages between neurons) being establlished. The senses are developed and refined in the first few years of life, with sight developing to almost adult levels in the first 3 - 6 months of life and touch and hearing developing further from what it was in the womb by 3 years of age. The senses, as well as finer motor and muscular control, speech centers and various other functions continue to be refined over the entirety of childhood. And just as important as the physical components of brain development is the development of emotions and responses to the world. Child abuse and neglect can impair, inhibit or slant the development of these as well to shape how somebody turns out.
The Importance of Teenage development:The second image isn't showing that 14 year olds are dumber than 3 and 6 year olds, but rather shows the process of optimisation of brain signalling pathways and pruning of unnecessary synaptic connections to make the brain more efficient - something that occurs during adolescence. In particular, the frontal lobe, responsible for a lot of higher order thinking and risk taking behaviour develops in adolescence, making those abused or neglected at those ages less likely to be well adjusted in later life. The teens are are also a time of learning, and figuring out one's place in the world, and social interactions (which can be interfered with by abuse), are just as impactful as physicat and emotional abuse at this stage of development.
What Causes Disruptions In This Development?
- Sexual Abuse
- Physical abuse/torture
- Mental/emotional abuse
- Exposure to domestic violence
- Substance abuse
- Substance/drug abuse
- Physical Illness
- Difficulty with school work/maintainence of expectations
- Lack of attention from parents
- Post Partum depression (occurs in 5 - 25% of women and causes a less loving enviornment)
- Too much work or expectation.
Child abuse occurs in younger people more often than older ones too and have more severe implications for younger people; of the 1760 fatalities in the US due to child abuse, 3/4 of the children were under the age of 4 . Remember, these issues are even more prevalent in the developing world.
In the words of Doctor Dawson, who works with trauma victims in both Australia and various parts of war torn Africa and the Middle East, the trauma victims in Australia suffer similar levels of trauma, despite having been subject to seemingly lesser abuse, maybe because unlike in Africa, they're isolated and alone.
Mechanisms of Abuse Impacting Development:
How Stress Impairs Development
The Direct Effects on the Brain:
This is crucial in terms of treatment, as it shows that reintroduction of a parental figure or adult role model soon after loss of that connection is vital to a child's short AND long term health.
The Increased likelihood of Poor Learning and Future Lifestyle Choices
Caused by Decreased Cortical Stimulation at Young Ages:
Trauma; How It Develops From Abuse:
Personality Disorders and Emotional Damage
Biological deficiencies cannot describe all aspects of the effects of child abuse, especially the emotional effects. The attachment theory can be used to describe an array of social problems that many children and adults impacted by child abuse seem to have. Children who were well nurtured and cared for develop secure attachments, and feel relationships with themselves and others that are loving and effective. Ambivalent attachment describes those who were subjected to neglectful, or unreliable parenting, resulting in jealous, clinging, obsessive, self-sacrificing individuals who feel relationships and love to be a series of highs and lows. Avoidant attachment describes parenting that is hostile, cold or controlling in nature, and results in detached, sometimes overly self reliant, closed off people unwilling to trust in others. Disorganised attachments indicate parents who tend to be frightened or anxious in their interactions with their child, and disorganised children see themselves as a problem, as weak and suffer from depression and self-esteem issues. 
Identifying Child Abuse in Children
Exactly what constitutes child abuse or neglect, and what warrants attention is a difficult question to answer. It varies from state to state and country to country, and again, we'll look at mainly developed countries', who have better child protection services and systems (and are better able to man them) set up, first before delving into the hard task of controlling third world child abuse, neglect, the effects of conflict, disasters and war, and malnourishment patterns.
In Australia alone, there are many definitions. Mandatory reporting is emphasised in many countries like Australia and America, but even that becomes unclear when looked at under the radar, as seen in the graphic below.
Signs of A Child Being Abused:
If you, whether you be a doctor, medical student, nurse or anyone who knows a child, notice any of these signs, do consider notifying authorities about these issues.
Other, non physical signs of child abuse and neglect, include repeated presentation to doctors/hospitals with different or untreated medical issues and non-compliance with medical treatments. The UK considers non compliance with vaccination regimes as child abuse and rightly so (here's why).
If children appear not well adjusted, or shows marked dissociation from the expected behavioral or emotional state, or show or talk about signs and symptoms of repeated stress, such as recurrent nightmares, extreme distress, withdrawal of communication, body rocking, aggression, it may indicate some occurrence of child abuse, though it's often hard to tell. States of over-clinginess, controlling/coercive behaviour, attention seeking habits and other signs of delayed or faulty interpersonal communications may also indicate some sort of child abuse, but again, it's hard to say.
More leading signs that point toward child maltreatment or over-stress include showing dissociation, trauma symptoms, if the child doesn't present regularly to school or daily activities, if they behave unexpectedly in examinations and overreactions to minor stresses.
The physically visible symptoms, and when to alert authorities are at the bottom of the post:
Childhood Coping Strategies:
Adult Coping Strategies:
Dealing With Child Abuse:
In the general community, reasons for this include confusion at the whole process, and how it works. Many feel that "because they don’t have proof and, if they’re wrong, they fear it will reflect badly"  and that the reporter or the person reported can have their reputations tarnished. This, however, is due to a lack of awareness about the protocols. Only suspicion is required to make a report, not proof and these reports can be done anonymously. As I said before it's safer to err on the side of caution, but this would be more easily achieved if there was more public awareness about the issue. A focus on fixing this issue is stressed in Australia's Council of Governors National Framework for Protecting Children , but the measures target only sexual abuse prevention, and it's listed as of last priority in New South Wales' child abuse prevention strategy  despite it being shown to work . Societal confusion as to what entails child abuse is another factor which can again be increased by public awareness of reporting measures, but this isn't done enough and needs to be increased in priority (though it could be argued that funding here will reduce the money directed towards an already floundering front line).
Another issue which can't really be dealt with is the lack of involvement, or of the reporter in the follow-up of child abuse reports. This is done for privacy and professional reasons, but if someone is suspicious enough to report it, they're most likely worried, and though sometimes information is give, if deemed safe, nothing is, or can really be done to ease that worry.
In terms of professionals working with kids, who are required in the US, Australia and Canada to report cases, there is also a reluctance to report. It's more concerning, as they're the ones most closely associated with kids, and in the case of healthcare workers, they're the most accurate, reliable notifiers and recognisers of child abuse.
The reasons why include lack of awareness of the signs and symptoms of child abuse in particular, limited experience, poor documentation, low opinion of child protection services and lack of emotional support through the process . In the case of doctors, 21% chose not to report cases of suspected child abuse  for similar reasons to above, with the added concern of legal repercussions and compromise of the relationship and treatment of the child/family concerned. In extreme cases, where stripping of parental rights is considered, there has to be a balance between the trauma and developmental issues caused by the losing a parental figure and the risk of further abuse incurred by staying with them. In the case of a mother needing a child to focus on however, the child's safety must come first.
Fixing this involves further education (I'm doing my part here!) about the symptoms and signs of child abuse, its effects on the body and the workings of the child abuse system. Though there are guides for what should be learnt, there are no set requirements, and some universities do not offer much in the way of this during their courses.
But there are easy simple measures that can be taken to increase the rate of reporting too. As discussed above, there is an issue in documenting and hence following up on suspected child abuse reports. A study conducted in emergency departments found that a simple reminder-like note for follow up of children who presented with injuries resulted in a great increase of recording of the reason for injury (which is vital to determining if incidences were caused by child abuse), from 2% in the group without the note to 70% in the group with it, with further referral rates for issues also increasing .
Many problems in funding and resource allocation exist within existing child protection services worldwide. Front line crisis intervention is almost always severely overburdened. Issues in this, are high rates of non professional reporting caused by mandatory reporting, lack of funding in some vital areas, bureaucratic issues when cases cross state lines (this occurs all over the world), and also the struggle in maintaining staff, and ensuring little burnout in such a harrowing, never ending, draining and often thankless job.
Non professional reporting, reporting by those untrained in identifying child abuse, show lower rates of substantiation (14% in non professional reports versus 27% for professionals ) despite similar resources directed towards investigation and, though often in the right places, can lead to back-ups on an already overextended, waiting list heavy service (eventually leading to tragedies if cases are seen late).
A balance must be struck between getting proper warning and overburdening an already stressed systems, and policies need to be well thought out, and centers well resourced to cope with the extra demand. Economic downturns and other issues can also increase the burden, and funding to these services must be preserved, even increased during these times. With a focus on early intervention, which is appropriate, many teenagers, especially older ones, are held in waiting lists for excessively long periods of time, leading to more tragedies, and more damage occurring. Remember, in the teen years, risk taking behaviors and patterns for life are established, so they are still of vital import.
The sharing of information between states, departments and NGOs should also become more fluid. This has less to do with privacy than it has negotiating bureaucratic lines, but is being dealt with in some countries, like Australia and Scotland with the breakdown of these lines, and the establishment of nationally consistent systems  .
In a field such as this, where horrific abuses are sighted all the time, burnout of workers is of concern as well. Caring for the carers is necessary in ensuring children are cared for but is hard to achieve in such an emotionally draining field. Cognitive therapy, and incorporating the issue of compassion fatigue in training does help in reducing this burden , but again, increasing the staff, to reduce the burden put on these workers in the first place is the best solution.
Policy Improvements to Focus on Prevention:
Treating, Counselling and Managing Child Abuse Sufferers in Ideal Settings
The Phases and Treatment of Crisis Situations
What happens after notifications
- Precipitating Event: The unusual, unanticipated, of continual stress occurs and in this time, authorities are notified. If perpetrated by other outside the immediate family, a period of helplessness is incurred and confusion about the intervention itself may cause further damage to the child or family environment.
- Perception: The family and abused child may feel their relationship and family unit threatened by the investigation at this point. Or they may find it meaningful and reassuring, depending on the circumstances.
- Disorganised Reponse - Unfamiliar vulnerable feelings start to rise and escalate as behaviors and coping mechanisms used in the past to get past stresses fail in the light of further investigation or a traumatic event. Family and child's anxiety rises and stress builds up. If this phase is prolongued, the intvestigation/intervention may lead to further harm.
- Seeking New and Unusual Resources/Ties - Families and children turn to other people, be it neighbours, relatives or friends. Since different family members and the child have different perceptions, and they may seek validation for their own viewpoint, or may get advice from others such as "Be more submissive and your father/mother will calm down," "Leave the abuser" etc.
- A Series of Chain of Events - Most crises, and the responses thus far set of further events which can cause further issues and further harm to the child. Personality/mood changes due to the investigation/interventions and conflicting feelings may lead to further violence, or the spending of rent/grocery money on drugs/alcohol to cope. Eviction of the child or parents may occur, setting off more crises.
- Previous Crises Become Linked to Current one: The events occurring may spur memories of past traumatic events or similar occurrences, and reliving experiences of previous traumas such as flashbacks may occur.
- Mobilisation of New Resources after Intervention Works and Adaptation - A turning point occurs as tension and struggle evolve and healing can begin. The family member causing abuse may go to alcoholic anonymous meetings and start seeing effects of it, a job may occur or in the case of removal from the home, a child may settle into a new home. Issues occur beyond this time, so counselling and follow up is definitely needed.
Crisis management strategy:
- Rapidly Establish a Constructive Relationship - During this stage, the crisis worker must be sincere, respect everyone's feelings and be an active listener. A Rapport has to be developed with everyone invovled, and a good first session must be had to ensure that further consultations and attempts to help can still occur.
- Elicit and Encourage Expression of Current Painful Feelings/Emotions - Anger, frustration and feelings relating to the current crisis are the focus at this stage, linkages to past events come second.
- Discussion of Precipitatng Event: Chain of events leading up to and after the crisis are discussed. How the family adapted to it should also be discussed in this stage.
- Assessing Strengths and Needs: Involved assessment of strength and needs begins immediately and continues through these steps. Children and adults strengths, and problem solving skills are tapped into to get them through this period.
- Forumulation of a dynamic plan: Focus shifts to why something happened. This is a crucial point of dealing with the current crisis, and the viewpoints of all parties are considered.
- Restore Cognitive Functioning: The crisis worker attempts to explore strategies the families are willing to adopt and motivated to work towards.
- Plan and Implement Treatment: A concrete plan of action is put forward. The plan needs to be simple and easy at first to ensure they follow up on it. The crisis worker continues to counsel the family, but most of the work is left as "homework" for the family to do.
- Termination: Termination of support occurs when the family is back to functioning as before. The crisis worker continues to have meetings with the family, and any services that helped, such as access to counselors or family assistance packages are maintained if possible.
- Follow up: Meetings after the crisis is resolved are arranged. Putting a solid date on follow up meetings ensures that families keep working towards a goal.
In the US, policies are also adopted to improve the quality of foster care. The Success and Increasing Adoption Act 2008, for example, increased grants to foster carers for housing, medical and educational expenses, and also improves the ability of relatives to take step in and relieve the burden on foster carers while simultaneously providing more stringent checks to ensure they're taking good care of the children. But a focus on ensuring children leaving foster care are provided for is more prevalent, given the extremely high number of kids in foster care (800,000 in 2003) and the low rates of adoption of older kids in particular. The Foster Care Independence Act of 1999, as well as the Success and Increasing Adoption Act 2008, provides funding for life skill and transitional services for those leaving foster care by providing education and vocational training grants and basic lifestyle grants.
Therapy Beyond The Crisis Situation, For Children, Their Families and Adult Surivors:
When counseling a child, it's very important to acknowledge their different responses, to remain clear and to engage with them as appropriate, considering their age and what they've been through.
Making the victims realise that they're not alone, which I touched on above, also helps the abused children and adult survivors of child abuse more open, and responsive to getting help. The stigmitisation of child abuse victims by society plays a huge role in the isolation that victims fear and should also be addressed. That stigma will continue however, until more general awareness of the harms and effects of child abuse and the long term impacts of it dries up.
In the case of neglect, physical or sexual abuse (whether it be that directed towards the child or domestic violence) however, the major focus of therapy is on that of the abuser. Yes, children are taught coping mechanisms and encouraged to grow after abuse, but in abusive households, it's the abuser's, not the child's fault, that violence or abuse is occurring and they are the target of counseling and therapy. Who commits abuse? In terms of neglectful abuse, it is usually women who are the perpetrators, possibly because they're involved with children more, (this is where post partum depression, occurring in 5 - 25% of women plays a major role), accounting for 66% of neglect cases in the US . However, physical and sexual abuse was mainly perpetrated by men, with 55.5% of physical abuse perpetrated by fathers/step fathers, 12% from unrelated men, and 90% of sexual abuse occurring by men .
Counseling the abusers is a highly specialised area of work and needs to be done with care. Counseling isn't directed towards anger, as many of these abusers control their anger well, can manipulate their thought processes and direct them towards children. Couple counselling alone isn't ideal either, as couples will likely break off into their own narratives and isolate eachother more or manipulate eachother in sessions (remember, many victims of abuse still love the perpetrators of the abuse, they're still family in a lot of cases) causing ineffective therapy. Good therapy of the abuser needs to show the abuser that they are the problem, gently, and though their issues, which may cause them to be abusive, do need to be dealt with through boosting their self esteem and cognitive therapeutic control techniques, it should be done in a context where they know they need to change their patterns of abuse. In the case of repeated abuse, or when crimes are committed however, crisis intervention needs to take place and children may need to be removed temporarily or permanently from the environment. Remember - the child should never be placed in harms way to protect the adults in therapy either.
For children put into foster care, counseling is aimed at both the carer and child and improving their relationship. Education of the needs of a child at certain ages, cultural and ethnic differences, and teaching children to cope is taught directly to foster carers (because remember - foster care is designed to be temporary while adoption is permanent) is the aim of therapy here. For the child, the initial loss of family, the subsequent feeling of abandonment and the feeling of belonging to many families (a lot of whom they don't properly belong to) is hard to get over, and the establishment of healthy coping mechanisms and a supportive environment is necessary to ensure they turn out as functional as possible.
Improving How We Look at Counseling:
Fixing the problem before it becomes an issue
Most child abuse therapy is focused on fixing problems once they occur. However, little focus is given to dealing with the risk factors that make someone more likely to commit child abuse. Strong correlations can be drawn between child abuse, particularly in chronic neglect perpretators and those of lower socio economic status, with histories of drug and alcohol abuse, histories of domestic violence, mental health problems  as well as the psychopathology and impaired social interactions of the parents themselves . For a long while, it was though that only the latter, something "wrong" or "screwed up" in the parent's psychology would lead to abuse, but the fact is that many more common issues such as those listed above, can also make someone more prone to perpetrating child abuse. The fact that child abuse becomes more common during recession is obvious in the significant rise of acute head traumas due to physical child abuse rising from 8.7 per 100,000 per year in 2004 to 14.7 per 100,000 a year in 2009,(a period of recession) in the US  and similar trends are seen over all types of child abuse around the world, showing clearly that stressful times, rather than psychological impairments cause child abuse.
Treating the stress of parents, and removing stresses from the overall environment will reduce incidence and prevalence of child abuse. But little focus is put on this. Granted, most of these issues are caused by hard to control factors, such as market forces, but counseling and therapy through simple things like public service announcements and the advocacy of parenting programs, discussed above, during hard times will reduce the occurrence and effects of child abuse. And improving access, and seeking out of counseling and therapy to parents going through hard times will reduce chances of child abuse occurring too.
Managing/Counseling Trauma Victims:
- Achieving Patient Safety, Reducing Symptoms and Increasing Competencies - getting children and adults past their initial anxiety, or controlling symptoms, and importantly, removing triggers which can cause dangerous (to both the physical and mental health of the victim) reactions. Medications may be helpful in helping patients to sleep or reduce anxiety, other issues listed above need to be dealt with and ability to function basically needs to happen before therapy designed to reduce the impact of the traumatic events can begin.
- Review and Appraise Trauma Memmories
The success of this phase of treatment depends on the ability of the victim to relive the memories. In patients exposed to single traumas, as opposed to those who suffered multiple, complex trauma, this is usually achieved quicker. There are three major pathways in this stage.
Exposure Therapy basically involves showing the victims signs or reminders of traumatic experiences over and over again until it stops having a response. In children in particular, evidence suggests this works best with combination with cognitive behavior therapy (in a process called Trauma-focused Cognitive Behavior Therapy [TF-CBT]), where the child is given physical or mental cues or actions to take when seeing that trauma to be able to tolerate it.
Reprocessing therapy, where the therapist tries to reprocess the way the memory is activated to a less emotionally charged one (the explanation of how traumatic memories are processed is in section 2), is another way. Eye movement Desensitization and Reprocessing is an evidence based method of doing this. A positive memory or experience for the patient is found to control any flare ups first, then a patient is required to perform a simple motor task, often moving the eyes side to side (following the therapists finger) while reliving the traumatic memory, until it has little impact.
Somatic Therapies are newer, and have less backing to them, but go through another process altogether, and don't involve reliving the experience at all. Basically, patients are taught to adapt and grow beyond the experience, often with focus on physical advancements, but basically the aim is to leave the past behind, minimise any impacts of trauma that do come up, and keep a focus on the future. I guess it's how I dealt with my cancer in that way (it's changed my ideology I guess - I always look at the big picture now).
- Consolidating The Gains:
Focus and improvements in social interactions is the final stage.
If you're interested, or an abuse victim yourself, the Adults Surviving Child Abuse Childhood website is a great resource for more information.
How we deal with Child Abuse in Wartorn/Disaster Regions Teaches Us How To Restore Communities and Economic Activity
Which Reduces Incidences of Child Abuse
Restoring The Economy:
Why and how we see being green not only good for the environment, but profitable too.
Urbanisation is occurring at rapid rates, as people exit rural communities as there are simply not enough jobs there to provide. The improvement of rural communities and improving resources and businesses, the major being agriculture there is one way to go about change, but rapid urbanisation has led to the growth of megacities, which are not only areas of mass squalor and poverty, but also hubs of child abuse, slavery and labour too. The lack of employment there similarly leads to issues for children, but there is plenty of labour in the informal sector there, and the providence of education on building, plumbing/dealing with sanitation and other sectors not only improves the conditions of slums in the area, but also their economic activity leading to a productive economy, higher ability to attain education and eventually, less instances of child abuse.
Cites Alliance is an organisation which focuses on slum upgrading, and provides the materials, and utilises the labour and the community inside the slum to cause change, and this is an excellent article showing how they've caused huge changes in the slums of Agra.
Microloans, and microcredit are a way to increase economic activity dramatically. Basically, they work by giving small scale loans, starting from $25 and going up, without the need for collateral or a source of income that's already there which stops many in the third world from getting a loan to beat their poverty. Through these loan, people can purchase products, materials or get education to help them out in their daily lives, and gain an ability to earn an income. Most loans given out are given to entrapeneurs, and even though there's no collateral, the repayment rates are over 99%, due to a huge sense of gratitude and cultural significance placed on helping them out in their time of need. The best thing about these foundations is that they often create businesses and give people a way to get employment; which stimulates economic activity not only for the person who's gotten the loan, but also their community around them. And they often go towards women too, which doubles the workforce. Organisations like Kiva.org, and the Grameen Foundation, are there, and you can get involved too!
On Kiva.org, you can pick and choose who you want to make a loan to, and can sort out sectors you're interested in and make a change that way, and most importantly, you get the money paid back to you to donate again or withdraw if you need to. It's actually a great way to save money - it makes sure I don't waste it that's for sure - and you change lives in the process! I give a $25 loan a week to add to my balance and am continually getting paid back and redonating the money, and you should get on it too!
An example of the work Dr Jennifer Dawson does is below.
Dealing With Trauma in the Third World
Dr Dawson enters communities and provides basic training on the recognition of trauma, how to control the symptoms and basic counseling as well to adults, such as school teachers, policemen and military, wanting to help. The role of these adults, and what they can do is amazing. In communities where many children are orphans, and many have seen their parents killed, were made to go through the trauma of killing or raping their own parents themselves, these teachers, farmers, and soldiers become mothers and fathers to the children, and allow them some semblance of normal development from youth (which is vitally dependent on an adult figure, not only in the first 3 years of life, but particularly from the ages of 6 - 12 where they develop moral characteristics and need an adult role model in life).
In terms of the trauma, she integrates herself with the community, teaches teachers to do the work she does and basically attempts to control trauma symptoms and reduce the amount of triggers out there. One example she gave, was the littering of skulls and bones and human carcasses, done purposefully to scare children in a school yard where she was doing her work. The presense of these bones and pieces of flesh were causing episodes of violence and biting among many children, as they relived some of their previous traumas. When these reminders, or triggers were cleared, the volence in the school stopped. It's not ideal, but it allows children to grow without that burden on their shoulders.
The fact that so many children in those areas have gone through trauma made group therapy and support more readily accessible. One thing she remarked on that struck me was that levels of trauma in Australia and the African nations she worked in were similar, despite the hugely different stressors that caused them, because in Africa there were so many others who'd been thruogh the same thing while in Australia, there was a sense of isolation. Not only in the survivors themselves, but in the community. We go months, sometimes years, sometimes our whole existence in our homes without speaking to our neighbours, while over there, that doesn't occur. She'd lectured 50 to 100 child and teenaged women at a time on how to cope with their sexual abuse, and in her last trip down there, did so to a class of young men too; a first. That openness and ability to cope is an advantage to achieving therapy.
When to Report or Suspect Abuse or Neglect
Bruising in shape of hand, teeth, stick etc.
Includes petechiae (red or purple spots)
If not caused by medical condition
Explanation is suspicious. Examples include:
- bruising of child not mobile
- multiple bruises in clusters
- bruises of similar size or shape around body
- bruising on non body parts of body, eg buttocks or face or eyes
- bruising is suggestive of strangling/constriction
- May be caused by animals or siblings
- Presense of bites on carer may suggest response by child (remember, most instances of child abuse are perpetrated by family members)
Lacerations (cuts)/ Scars
Again if explanation is suspicious and no medical condition established. Not necessarily perpetrated by adults, can be self harm, but that may indicate other abuse
What to look out for, scars/cuts that are:
- Symetrical in distribution
- On areas usually protected by clothing
- On ears or face
- On neck/ankles/wrists
- Children that are immobile
Burns that are suspect of abuse include those with improper explanations again, but also suspect abuse/neglect:
- If child is not independently immobile.
- If burns are on hands, soles of feet, buttocks etc.
- In the shape of an instrument, eg, cigarette
- Indicate forced immersion into hot water, eg. scalds to buttocks, limbs, symetrical in distribution or with sharply delineated borders
Cold injuries, including hypothermia are suspect of neglect or physical harm.
If explanation isn't suitable and evidence is clear of physical abuse. More obvious.
In absense of major confirmed accidental trauma or medical cause, suspect abuse if:
- Explanation is absent or unsuitable
- Child is under 3 years of age
- There are also retinal haemorrhages (bleeding), rib or long bone fractures or other associated injuries.
- Multiple subdural (below outer surface of brain) haemorrhages with or without subarachnoid haemorrhage or ischamic damage
Suspect abuse/neglect when no obvious accidental trauma confirmed. Signs of abuse include:
- Findings on skeletal imaging.
- Neck injury associated with inflicted head injury
- Unexplained kyphosis (curvature or deformity of spine)
- Back injury with focal neurological symptoms too
Eye trauma, General Injury, Oral Injury and Organ damage
Suspect if explanation unsuitable and congenital abnormalities/other defects ruled out.
Signs of Sexual Abuse:
When to Report or Suspect Abuse/Neglect
Ano-genital Signs and Symptoms
Suspect if child has symtpoms or signs like:
- Genetial/Perianal injury (bruising, laceration, swelling or abrasion) and explanation isn't present or suitable
- Persistent or recurring genital/anal symptom (bleeding/discharge) that has no medical explanation
- Has anal fissure, constipation and Crohn's disease and passing hard stools has been excluded as cause
- Gaping anus is examined and no medical explanation available
- Dysuria that is persistent and recurrent with no medical explanation like worms, poor hygiene, allergies or kidney issues/infections
- If foreign bodies are present in vagina or anal cavity
Sexually Transmitted Infections
Consider sexual abuse if child has:
- Hepatitis B without non sexual medical explanation (mother to son transmission, or other non sexual transmission like blood contamination)
- Anogential warts without other explanation
- Gonorrhoea, chlamydia, syphilis, genetal herpes, Hep C, HIV, trichomonas or other STI infection without other explanation
For those above age of consent, but with other issues such as a clear difference in mental capability, incestuous relationship or relationship with figure of trust such as a coach, teacher, minister of religion also apply
For all of the above - differing age of consent laws for differing countries also play a factor and should be considered appropriate to your setting.
Similar to above, consider sexual abuse, appropriate to your local laws, if someone presents pregnant and is under the age of consent or has "other issues" described above.
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